The Effect of Neutropenia and Filgrastim (G-CSF) in Cancer Patients With COVID-19 Infection

Background: Neutropenia is commonly encountered in cancer patients, and recombinant human granulocyte colony-stimulating factor (G-CSF, filgrastim) is widely given to oncology patients to counteract neutropenia and prevent infection. G-CSF is both a growth factor and cytokine that initiates proliferation and differentiation of mature granulocytes. However, the clinical impact of neutropenia and G-CSF use in cancer patients, who are also afflicted with coronavirus disease 2019 (COVID-19), remains unknown. Methods: An observational cohort of 304 hospitalized patients with COVID-19 at Memorial Sloan Kettering Cancer Center was assembled to investigate links between concurrent neutropenia (N=55) and G-CSF administration (N=16) on COVID-19-associated respiratory failure and death. These factors were assessed as time-dependent predictors using an extended Cox model, controlling for age and underlying cancer diagnosis. To determine whether the degree of granulocyte response to G-CSF affected outcomes, a similar model was constructed with patients that received G-CSF, categorized into high- and low-response, based on the level of absolute neutrophil count (ANC) rise 24 hours after growth factor administration. Results: Neutropenia (ANC < 1 K/mcL) during COVID-19 course was not independently associated with severe respiratory failure or death (HR: 0.71, 95% Cl: 0.34-1.50, P value: 0.367) in hospitalized COVID-19 patients. When controlling for neutropenia, G-CSF administration was associated with increased need for high oxygen supplementation and death (HR: 2.97, 95% CI: 1.06-8.28, P value: 0.038). This effect was predominantly seen in patients that exhibited a high response to G-CSF based on their ANC increase post-G-CSF administration (HR: 5.18, 95% CI: 1.61-16.64, P value: 0.006). Conclusion: Possible risks versus benefits of G-CSF administration should be weighed in neutropenic cancer patients with COVID-19 infection, as G-CSF may lead to worsening clinical and respiratory status in this setting.

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A multicenter analysis of the outcome of cancer patients with neutropenia and COVID-19 infection optionally treated with granulocyte colony-stimulating factor (G-CSF).

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.12105 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 12105-12105

Author(s):

Ana M. Jimenez Gordo ◽

Gonzalo Colmenarejo ◽

Javier Baena Espinar ◽

Carlos Aguado ◽

Xabier Mielgo ◽

...

Keyword(s):

Logistic Regression ◽

Respiratory Failure ◽

Cancer Patients ◽

P Value ◽

Tumor Type ◽

Patients With Cancer ◽

Patient Status ◽

Multicenter Analysis ◽

Multiple Variables ◽

Stimulating Factor

12105 Background: Infection by SARS-CoV-2 can turn into an acute respiratory infection. Approximately 15% of patients will develop a distress syndrome responsible in most cases of mortality. A host hyperinflammatory response induced by a cytokine storm, is the main cause of this severe complication. Chemotherapy myelosuppression is associated with higher risk of infections and mortality in cancer patients. There have been no previous reports about the clinical management of patients with neutropenia and concomitant COVID-19. Herein, we present a multicenter experience in several hospitals during COVID-19 outbreak in neutropenic cancer patients infected by SARS-Cov-2. Methods: Retrospective clinical data were collected from clinical reports. Protocol was approved by a Clinical Research Ethics Committee (HULP: PI-4194). Inclusion criteria were cancer patients with neutropenia (<1500 cells/mm3) and concomitant COVID-19 infection. Comorbidities, tumor type and stage, treatment, neutropenia severity, filgrastim (G-CSF), COVID-19 parameters and mortality were analyzed. Exploratory analysis included a description of all data collected and bivariate analyses among different pairs of variables, including their impact in mortality in this cohort. In addition, multivariable logistic regression was used to predict respiratory failure and death as a function of multiple variables. Results: Among 943 patients with cancer screened in 14 hospitals in Spain, eighty-three patients (8%) had a febrile neutropenia and COVID-19 infection. Lung (26%), breast (22%), colorectal (13%) and digestive non-colorectal (17%) cancers were the main locations and most patients had advanced disease (67%). Fifty-three (63%) of patients included died because respiratory failure. Neumonia was presented in 76% of patients, bilateral in 47% and 12% of all patients had thrombotic events. The median of neutrophils was 650cls/mm3 and 49% received G-CSF with a median of days on treatment around 4,5 days. Among all variables related with mortality in neutropenic cancer patients with COVID-19 infection, we found that the number of days with G-CSF showed a significant trend toward worse outcome and higher mortality. In particular, a logistic regression model was developed to predict respiratory failure, as a function of the number of days of G-CSF treatment. As adjusting covariates, sex, age, treatment purpose (palliative vs curative, to adjust for patient status), tumor type, and the lowest level of neutrophils in the patient (to adjust for neutropenic status) were used. A significant effect was obtained for the days of G-CSF treatment (OR = 1.4, 95% CI [1.03, 1.92], p-value = 0.01). Conclusions: Our findings suggest that a prolonged G-CSF treatment could be disadvantageous for these cancer patients with COVID-19, with a higher probability of worse outcome.

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Myeloablative Chemotherapy for T-Cell Lymphoma: a Case for Autologous Stem Cell Transplantatin (Auto) in First Remission.

Blood ◽

10.1182/blood.v112.11.1141.1141 ◽

2008 ◽

Vol 112 (11) ◽

pp. 1141-1141 ◽

Cited By ~ 1

Author(s):

Issa F Khouri ◽

Adriana Lopez ◽

Grace-Julia Okoroji ◽

Martin Korbling ◽

Gloria McCormick ◽

...

Keyword(s):

T Cell ◽

Cell Lymphoma ◽

Cox Model ◽

Performance Status ◽

Autologous Transplantation ◽

T Cell Lymphoma ◽

Cancer Center ◽

P Value ◽

Significant Difference ◽

First Remission

Abstract In order to determine the long-term impact of AUTO in patients (pts) with T-cell lymphoma, we examined the outcome of 79 pts transplanted at the MD Anderson Cancer Center, in first partial or complete remission (CR) (AUTO1, n=20) or for relapsed / refractory disease (AUTO2, n=59) between 06/91 and 05/08. <<<PATIENTS>>> Median age (range) at transplantation was 49 (22–65) and 51 (16–77) for the AUTO1 and AUTO2 groups respectively (p=0.35); other baseline characteristics including gender, stage, B-symptoms, LDH, IPI, PET/Gallium status, history of marrow involvement, and performance status at transplantation were similar. There was a statistically significant difference between AUTO1 and AUTO2 with respect to histology {peripheral t-cell, angioimmunoblatic, and anaplastic/large cell were present in 80%, 5%, 15%, respectively in AUTO1, and 42%, 10%, and 45%, respectively in AUTO2 (p=0.02); one pt in AUTO2 had small lymphocytic and one had hepatosplenic T cell lymphoma}. Statistically significant differences were also noted with respect to B2-microglobulin (P=0.02; favoring AUTO1), number of prior chemotherapy regimens received {median 1 vs 3 for AUTO1 and AUTO2, respectively (p <0.001)}, disease status at transplantation {18% of AUTO2 had stable or progressive disease at transplant vs 0% in AUTO1 (P < 0.001)}, and # of CD34+cellsx10 6/Kg infused {median 9 vs 5 for AUTO1 and AUTO2, respectively}. Most pts in both group received BEAM as conditioning. Median follow-up time in months was 64 (95%CI, 31–87), and 47(95%CI29–121) for AUTO1 and AUTO, respectively. Median overall survival (OS) was 43.5 months (95%CI:30–70 for AUTO2 and the median OS was not reached for AUTO1 (P=0.01)(Figure). The median progression-free survival (PFS) was 16 months (95%CI:8–56) and 95 months (95%CI:6.94-NA) for the pts in the AUTO2 and AUTO1 groups, respectively (P=0.06). Univariate Cox models for OS showed that AUTO2 vs AUTO1 (HR 3.4, P=0.02), high LDH level (HR 2.6. P=0.01), PET/Gallium+ (HR 2.8, P=0.01), IPI2–4 (HR 3.4, P=0.002), marrow involvement (HR 6.3, P=0.02), and marrow vs peripheral blood as source of graft (HR 2.1, P=0.048) were important determinants of outcome. The univariate Cox model for PFS showed that only AUTO2 vs AUTO1, hi LDH, IPI and PET/gallium were statistically significant. A multivariate analysis that included the covariates with the lowest P value showed that AUTO2 vs AUTO1 remained the only important factor for OS (HR 4.79, P=0.035) while PET/ Gallium status at transplantation was the most important determinant of PFS (HR 3.13, P=0.006). <<<CONCLUSION>>> Autologous transplantation has the potential to cure a proportion of pts with t-cell lymphoma if performed during the first remission. Alternative strategies are needed for pts transplanted beyond first remission especially if they continue to have avid functional imaging at transplantation. Figure Figure

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Reduced 90-day postoperative mortality through geriatric comanagement after cancer surgery.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.11512 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 11512-11512 ◽

Cited By ~ 1

Author(s):

Armin Shahrokni ◽

Amy Tin ◽

Saman Sarraf ◽

Koshy Alexander ◽

Soo Jung Kim ◽

...

Keyword(s):

Cancer Patients ◽

Preoperative Evaluation ◽

Frailty Index ◽

Postoperative Mortality ◽

Operation Time ◽

Urgent Care ◽

Hospital Length Of Stay ◽

Cancer Center ◽

P Value ◽

Estimated Blood Loss

11512 Background: We explored the association between geriatric comanagement and 90-day postoperative mortality of cancer patients aged 75 or older. Methods: A retrospective review of a prospectively maintained database was performed on patients over 75 years old who underwent elective surgery with hospital length of stay of ≥1 day at Memorial Sloan Kettering Cancer Center from 2015-2018. Geriatric comanagement group (GCG) patients had geriatric preoperative evaluation and inpatient geriatric comanagement. Patients in the surgical management group (SMG) did not have geriatric preoperative evaluation or postoperative geriatric comanagement. We utilized a multivariable logistic regression model with 90-day mortality as the outcome, geriatric co-management as the predictor, and adjusted for age, gender, American Society of Anesthesiology score, Memorial Sloan Kettering Frailty Index, preoperative albumin level, operation time, and estimated blood loss. The same logistic model was used to assess the association between adverse surgical events within 30-days (any major complication, readmission, or urgent care center visit) and geriatric comanagement. Results: Of 1,855 patients (median age 80), 1,009 patients (54%) were co-managed by geriatricians. GCG patients were slightly older, less likely to be male, had longer operation time, and stayed in the hospital longer. Adjusted rates of 90-day mortality was lower in GCG vs. SMG (4.3% and 9.2%, respectively; 95% CI around difference -7.3%, -2.5%; p-value < 0.0001). We did not find evidence of a difference in adverse surgical events between groups (OR 0.96, p-value = 0.8). A greater proportion of GCG patients received inpatient physical therapy (80% vs. 64%) and occupational therapy (37% vs. 25%) compared to SMG patients. Conclusions: Our study shows that geriatric comanagement is associated with reduced 90-day postoperative mortality in cancer patients aged ≥75. A randomized trial study is needed to confirm this finding.

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Clinical Characteristic of Thoracic Malignancy Patients with Coronavirus Disease 2019 Related to Mitigation Strategy in Dharmais National Cancer Center Hospital, Indonesia

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.6525 ◽

2021 ◽

Vol 9 (B) ◽

pp. 692-697

Author(s):

Arif Hanafi ◽

Noorwati Soetandyo ◽

Achmad Mulawarman Jayusman ◽

Leovinna Widjaja ◽

Fifi Dwijayanti ◽

...

Keyword(s):

Cancer Patients ◽

Disease Severity ◽

Poor Prognosis ◽

Severe Disease ◽

Mitigation Strategy ◽

Cancer Center ◽

P Value ◽

Lymphocyte Ratio ◽

Thoracic Malignancy ◽

D Dimer

Aim: To describe the clinical data and disease severity of thoracic malignancy patients with COVID-19 and its relation to the mitigation process at the Dharmais National Cancer Center, Indonesia. Methods: Total 5256 cancer patients registered from May 2020 to March 2021. There were 681 cancer patients diagnosed with COVID-19. Forty-five thoracic malignancy patients were enrolled. Data from medical records were obtained at the Dharmais Cancer Hospital, then analyzed using SPSS version 25. Comparative result was considered significant, as p-value < 0.05. Results: There were 12.9% of total patients registered infected by COVID-19, which 6% with thoracic malignancy dominated by Non-small cell lung carcinoma (57.8%). Patients who have asymptomatic (31.1%), mild (13.3%), and moderate COVID-19 disease (8.9%) were alive. Patient with severe disease (46.7%) tend to deteriorate. Neutrophilia (mean 78.0%), lymphopenia (mean 13.0%), high neutrophil to lymphocyte ratio (mean 13.1), hyperuricemia (mean 31.6 mg/dL), high fibrinogen (mean 521.7 mg/dL), and high d-dimer (mean 3821.6 ng/mL) were significantly associated with disease severity (p-value < 0.05). Conclusions: Only small number of cancer patients affected by COVID-19 and mostly do not progress to severe disease, showing the strict mitigation strategy was successful. Severe disease patients have a poor prognosis, with neutrophilia, lymphopenia, high neutrophil to lymphocyte ratio, hyperuricemia, high fibrinogen, and high d-dimer may be valuable for predicting poor prognosis.

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Cytokine Analysis in 154 Patients with Transient Abnormal Myelopoiesis: Jccg JPLSG TAM-10 Clinical Study

Blood ◽

10.1182/blood-2021-149116 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 2362-2362

Author(s):

Genki Yamato ◽

Myoung-Ja Park ◽

Akira Shimada ◽

Norio Shiba ◽

Yoshiyuki Yamada ◽

...

Keyword(s):

Growth Factor ◽

Early Death ◽

Therapeutic Interventions ◽

P Value ◽

Gm Csf ◽

Transient Abnormal Myelopoiesis ◽

Tnf Α ◽

Cytokine Levels ◽

Wbc Count ◽

Stimulating Factor

Abstract Introduction: Transient abnormal myelopoiesis (TAM), also known as transient leukemia or transient myeloproliferative disorder, is a unique clonal myeloproliferation characterized by immature megakaryoblasts occurring in 10% of neonates with Down syndrome. Although most patients show spontaneously resolution of TAM without therapeutic interventions, approximately 20% of TAM cases result in early deaths, i.e., within 9 months, and approximately 20% of the survivors develop acute megakaryoblastic leukemia (AMKL) within 4 years. A somatic GATA1 gene mutation that leads to the exclusive expression of a truncated GATA1 protein is shared by both TAM and AMKL cells. According to previous reports, cytokine levels are associated with liver failure, which is a cause of early death. Here, we analyzed 154 DS patients with TAM enrolled in the TAM-10 prospective observational study conducted by the Japan Pediatric Leukemia/Lymphoma Study Group to determine the association between clinical characteristics and cytokine levels in such patients. Patients and Methods: A total of 167 neonates (89 boys and 78 girls) diagnosed with TAM were prospectively registered in the TAM-10 study between May 2011 and February 2014. We analyzed cytokine levels in 154 of the 167 enrolled patients whose samples were available. Somatic GATA1 gene mutations were confirmed in 151 (98%) of 154 patients using Sanger and/or next-generation sequencing. Using the Bio-Prex cytokine assay, serum concentrations of the following 27 cytokines were measured: interferon gamma (IFN-γ), tumor necrosis factor alpha (TNF-α), vascular endothelial growth factor (VEGF), platelet-derived growth factor-BB (PDGF-BB), basic fibroblast growth factor (bFGF), granulocyte colony-stimulating factor (G-CSF), granulocyte-macrophage colony-stimulating factor (GM-CSF), monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory proteins alpha and beta (MIP-1α and MIP-1β), eotaxin, interferon gamma-induced protein (IP-10), regulated upon activation, normal T-cell expressed and secreted, interleukin I receptor agonist (IL-RA), and 13 different interleukins (IL-1β, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-9, IL-10, IL-12, IL-13, IL-15, and IL-17). For all analyses, P values were two-tailed and a P value of <0.05 was considered statistically significant. Mann-Whitney test were used as appropriate for comparisons between groups. Moreover, the cumulative incidence for competing events was compared with the Gray test. Results: The median (range) white blood cell (WBC) count at diagnosis was 37.2 (2.4-478.7) × 10 9 cells/L. Forty-seven (31%) of 154 patients received low-dose cytarabine. When we compared 29 patients with a high WBC count (≥100 × 10 9 cells/L, known as a poor prognostic factor in TAM patients) to 125 patients without a high WBC count for 27 cytokine levels, the levels of 16 cytokines (IL-1b, IL-1ra, IL-6, IL-7, IL-8, IL-9, IL-10, IL-13, Eotaxin, PDGF-bb, basic FGF, G-CSF, GM-CSF, MCP-1b, and VEGF) were significantly higher in patients with a high WBC group. Early death occurred in 14 (9%) of 154 patients. Cytokine levels were compared between the early death group (n = 14) and remaining patients (n = 140) and it was observed that the levels of 10 cytokines (IL-1b [p = 0.016], IL-1ra [p < 0.001], IL-6 [p < 0.001], IL-7 [p = 0.009], IL-8 [p < 0.001], IL-10 [p = 0.014], IL-13 [p = 0.002], MCP-1 [p = 0.030], MIP-1b [p = 0.024], and TNF-α [p = 0.008]) were significantly higher in the early death group. When the patients were divided in two groups according to the median IL-1β concentration showing the lowest p-value, the early death rate in the IL-1β high group was significantly higher than that in the IL-1β low group (16% vs. 3%, p < 0.001). IL-1, IL-6, IL-8, and TNF-α are proinflammatory cytokines induced by MCP-1 and MIP1-b. Early death was strongly associated with hypercytokinemia, suggesting that therapeutic interventions (e.g., systemic steroid therapy) may be effective in patients with hypercytokinemia. However, there was no relation between the levels of 27 cytokines and leukemia development. Conclusion: Our findings suggested that measurement of cytokine levels may be a useful marker for predicting early death and an indicator of therapeutic interventions required in TAM patients. Disclosures No relevant conflicts of interest to declare.

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Prognostic significance of the “surprise” question in cancer patients

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.9588 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 9588-9588

Author(s):

A. H. Moss ◽

J. R. Lunney ◽

S. Culp ◽

M. Auber ◽

S. Kurian ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

Cancer Patients ◽

Prognostic Significance ◽

Cox Proportional Hazards ◽

Cancer Center ◽

P Value ◽

Cancer Type ◽

Patient Death ◽

Surprise Question

9588 Background: In patients with advanced cancer, failure to accurately estimate and communicate prognoses can lead to overly aggressive care at the end of life with less attention to important palliative care issues such as pain and symptom management and patients’ values and goals for care. The “surprise” question—would I be surprised if this patient died in the next year?—has been recognized as an innovation to improve end-of-life care in the primary care population by identifying patients with a poor prognosis who are appropriate for palliative care. It has not been previously tested in cancer patients. The purposes of this study were to determine the feasibility and outcomes of the use of the “surprise” question in a cancer center population. Methods: Between July and November 2007, oncologists prospectively classified consecutive breast, lung, and colon cancer patients being seen at the Mary Babb Randolph Cancer Center of West Virginia University into “Yes” and “No” groups based on the surprise question. Patients were followed and their status at the end of one year-alive or dead-was determined along with patient demographics, type of cancer, and stage at presentation. A multivariate Cox proportional hazards regression analysis was used to identify variables associated with patient death. Results: Oncologists classified 826 of 853 prospective patients (97%), with 131 (16%) classified into the “No” group and 695 (84%) into the “Yes” group. At the end of the year, 71 patients had died; 41% of the “No” patients compared to 3% of the “Yes” patients (P <.001). The surprise question ‘No‘ response was more predictive of patient death than stage of cancer, cancer type, or age (hazard ratio 7.53, P value <.001). The “Yes” patients lived longer than the “No” patients (359.8±32.8 days versus 270±131.5 days, P <.001). The sensitivity of the surprise question “No” response was 75% and the specificity was 90%. Conclusions: We conclude that the surprise question is a simple, feasible, and effective tool to identify cancer patients with the worst prognoses who should receive the highest priority for palliative care interventions, particularly advance care planning. No significant financial relationships to disclose.

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Association of serum levels of the growth factor GP88 with disease progression in breast cancer patients

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e22021 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e22021-e22021

Author(s):

G. Serrero ◽

K. Tkaczuk ◽

M. Zhan ◽

N. Tait ◽

C. Ilan ◽

...

Keyword(s):

Breast Cancer ◽

Growth Factor ◽

Serum Level ◽

Disease Progression ◽

Cancer Patients ◽

Early Stage ◽

Serum Levels ◽

P Value ◽

Breast Cancer Patients ◽

Early Stage Disease

e22021 Background: The autocrine growth factor GP88 is an important player in breast cancer. GP88 is expressed in human BC tumors in correlation with their tumorigenicity. Increased GP88 expression was associated with anti-estrogen therapy resistance in ER+ cells and Herceptin resistance in Her-2 overexpressing breast tumors. Inhibition of GP88 expression inhibited tumor incidence and growth in nude mice. Immunohistochemical studies have shown that GP88 is expressed in invasive ductal carcinomas (IDC) and that high GP88 expression correlated with increased recurrence and mortality. Since GP88 is found in serum, we hypothesized that GP88 was elevated in the sera of breast cancer patients compared to healthy individuals and that GP88 serum level increases with disease progression. Methods: An IRB approved prospective study was established at the University of Maryland Breast Clinic to determine the serum level of GP88 in breast cancer patients (BC pts). Approximately 5 ml of blood was drawn every three months. GP88 serum concentration was determined in triplicate by human GP88 enzyme immunoassay. 190 BC pts were accrued. Sera from healthy volunteers (HV) were obtained to establish GP88 baseline. BC patient characteristics: Caucasian- 91, African American-92, Asian-6; median age, 51 (range 29- 86), stage I - 48, II - 52, III - 26, IV - 63. Results: Median serum GP88 level was 28.7 ng/ml (range 16.6–38.2) in HV, 40.7 ng/ml (range 6.4–100) in early stage (stage 1 -3) BC pts (p- value = 0.007) and 45.3 ng/ml (range 9.8 to 158.4) in stage 4 BC patients (p- value= 0.0007). Statistically significant increase in serum GP88 level was found in early stages as well as in metastatic disease when compared to HV. In addition, patients that were initially diagnosed with early stage disease but recurred showed a 5 to 10 fold increase in their GP88 serum levels. Conclusions: GP88 serum level is significantly higher in the sera of BC than HV subjects. Moreover, GP88 serum level increased in association with disease recurrence and progression. This study identifies GP88 as a measurable biomarker for disease progression not only at the tissue but also at the serum level. These results are also interesting since GP88 is also a therapeutic target of malignant progression of breast carcinoma. No significant financial relationships to disclose.

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A single-center study of cancer and chemotherapy-induced kidney disease.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e13062 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e13062-e13062

Author(s):

Abu-Sayeef Mirza ◽

Sarah Mushtaq ◽

Revati Reddy ◽

Mina Mousa ◽

Chandrashekar Bohra ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Cancer Patients ◽

Kidney Cancer ◽

Kinase Inhibitors ◽

Retrospective Chart Review ◽

Chemotherapeutic Agents ◽

Cancer Center ◽

P Value ◽

Renal Outcomes

e13062 Background: It is clinically understood that chronic kidney disease (CKD) and cancer are interrelated. Yet, few studies measure how renal outcomes vary according to common malignancies and common therapeutic agents. We report the incidence and the nature of CKD among cancer patients from a single institution. Methods: A retrospective chart review of cancer patients managed in the onconephrology clinic at the Moffitt Cancer Center from 05/01/2015 to 07/31/2016 was conducted. Patients with acute or chronic kidney disease secondary to a malignancy or side effect of chemotherapy were included in this study. Renal function outcomes were recorded at three-month follow-up intervals from the 15-month duration. Results: Out of the total 88 patients with median age of 68 years, 63 patients were diagnosed with chronic kidney disease, whereas the remaining had acute kidney injury. Kidney cancer and multiple myeloma represented the largest proportion with 12 patients each. Patients with kidney cancer had a mean creatinine of (2.35, 1.74) mg/dl compared to patients without kidney cancer with creatinine (1.97, 1.07) mg/dl. Abdominal cancers had the highest proportion of chronic kidney disease (84.21%) whereas 81.48% of patients with genitourinary cancers had chronic kidney disease. Patients prescribed tyrosine kinase inhibitors had a lower average estimated glomerular filtration rate (28.37, 9.86) mL/min/1.73 m2 compared to other chemotherapeutic agents, though this was a weakly significant relationship (p-value = 0.07). Similar renal outcomes according to malignancy and chemotherapy are reported. Conclusions: This group of patients demonstrated the frequency of chronic kidney disease differs depending on the type of malignancy or chemotherapy. A multidisciplinary approach involving oncologists and nephrologists should be adopted to prevent further renal damage from cancer and its therapies.

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Circulating levels of the breast cancer growth factor GP88 in the serum of breast cancer (BC) patients

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.20050 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 20050-20050

Author(s):

G. Serrero ◽

K. Tkaczuk ◽

N. Tait ◽

O. Golubeva ◽

H. Dai ◽

...

Keyword(s):

Breast Cancer ◽

Growth Factor ◽

Serum Level ◽

Healthy Volunteers ◽

Cancer Patients ◽

Critical Role ◽

Estrogen Therapy ◽

Breast Adenocarcinoma ◽

P Value ◽

Breast Cancer Patients

20050 Background: The 88 kDa autocrine growth factor PC-Cell Derived Growth Factor (GP88) plays a critical role in breast tumorigenesis. GP88 expression was low in estrogen receptor positive cells, whereas in ER negative cells, it was constitutively overexpressed. Increased GP88 expression was associated with anti-estrogen therapy resistance in ER+ cells and Herceptin resistance in Her-2 overexpressing breast tumors. Antisense inhibition of GP88 expression in human breast adenocarcinoma lead to inhibition of tumor growth in vivo. Immunohistochemical studies have shown that GP88 was expressed in 80% of invasive ductal carcinomas in correlation with expression of poor prognosis markers whereas normal tissues and benign breast lesions were negative. Since GP88 is secreted by breast cancer cells, we examined whether GP88 was found in the circulation at an elevated level in the sera of breast cancer patients when compared to healthy individuals. Methods: A blood sampling study was conducted to determine the serum level of GP88 in healthy volunteers (HV) and breast cancer patients (BC pts). Ten ml of blood was drawn every three months to obtain serum. GP88 serum concentration was determined in triplicate by quantitative enzyme immunoassay using human GP88 as standard. 126 BC pts were accrued. . In addition, sera from 53 healthy volunteers were obtained to establish a GP88 baseline in HV. BC pts characteristics: race: Caucasian- 61, African American-60, Asian-5; median age: 52.5 (range 26–84), stage I-32, II-34, III-18, IV-42. Results: Circulating GP88 was measurable in the serum. Median level of GP88 was 32.8 ng/ml (range 15.3–42.8) in HV and 43.8 ng/ml (range 15.4–158.4) in BC pts, (p-value = 0.0007). Conclusions: GP88 is measurable in the sera of HV and BC pts. Comparison between the two groups indicates that GP88 level is significantly higher in the sera of BC pts. These studies are important since it identifies GP88 as a measurable biomarker that is also a therapeutic target of malignant transformation or malignant progression of breast carcinoma (BC). Future studies will examine the correlation of GP88 level with BC prognostic factors. Correlation between the serum level of GP88 and therapeutic response to systemic therapy in breast cancer patients will also be assessed. [Table: see text]

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Oncologic immunomodulatory agents in patients with cancer and COVID-19

Scientific Reports ◽

10.1038/s41598-021-84137-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Justin Jee ◽

Aaron J. Stonestrom ◽

Sean Devlin ◽

Teresa Nguyentran ◽

Beatriz Wills ◽

...

Keyword(s):

Respiratory Failure ◽

Cancer Patients ◽

Supplemental Oxygen ◽

Cancer Center ◽

Corticosteroid Administration ◽

Patients With Cancer ◽

Hematologic Cancer ◽

Significant Difference ◽

Anti Cd20 ◽

Relative Prevalence

AbstractCorticosteroids, anti-CD20 agents, immunotherapies, and cytotoxic chemotherapy are commonly used in the treatment of patients with cancer. It is unclear how these agents affect patients with cancer who are infected with SARS-CoV-2. We retrospectively investigated associations between SARS-CoV-2-associated respiratory failure or death with receipt of the aforementioned medications and with pre-COVID-19 neutropenia. The study included all cancer patients diagnosed with SARS-CoV-2 at Memorial Sloan Kettering Cancer Center until June 2, 2020 (N = 820). We controlled for cancer-related characteristics known to predispose to worse COVID-19 as well as level of respiratory support during corticosteroid administration. Corticosteroid administration was associated with worse outcomes prior to use of supplemental oxygen; no statistically significant difference was observed in sicker cohorts. In patients with metastatic thoracic cancer, 9 of 25 (36%) and 10 of 31 (32%) had respiratory failure or death among those who did and did not receive immunotherapy, respectively. Seven of 23 (30%) and 52 of 187 (28%) patients with hematologic cancer had respiratory failure or death among those who did and did not receive anti-CD20 therapy, respectively. Chemotherapy itself was not associated with worse outcomes, but pre-COVID-19 neutropenia was associated with worse COVID-19 course. Relative prevalence of chemotherapy-associated neutropenia in previous studies may account for different conclusions regarding the risks of chemotherapy in patients with COVID-19. In the absence of prospective studies and evidence-based guidelines, our data may aid providers looking to assess the risks and benefits of these agents in caring for cancer patients in the COVID-19 era.

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